=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811434335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIAN RADZINSKI DPT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2017
-----------------------------------------------------
Last Update Date | 01/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 808 N BROAD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-236-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 586 WEBSTER AVE
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-7535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-210-4114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF PHYSICAL THERAPY / OWNER
-----------------------------------------------------
Name | DR. CHRISTIAN RADZINSKI
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 267-210-4114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 024495
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------